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Adding age and genetic risk to PSA test could improve screening for prostate cancer

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7467 (Published 06 November 2012) Cite this as: BMJ 2012;345:e7467
  1. Zosia Kmietowicz
  1. 1London

Targeting tests for prostate cancer at the men most likely to develop the disease could halve the number needed to be screened, reduce overdiagnosis, and potentially save the NHS millions of pounds, suggests research.

With funding from Cancer Research UK, researchers from London and Cambridge developed a model to estimate the cost and quality adjusted life years (QALYs) of a personalised screening programme compared with an age based screening strategy using data from English cancer registries and the ProtecT study (http://www.hta.ac.uk/1230) into the treatments for clinically localised prostate cancer.

Both strategies used the prostate specific antigen test every four years. All men in the age based programme were offered the test between the ages of 45 and 74 years and would each undergo eight rounds of screening in total. But in the personalised strategy programme only those with highest risk were screened. Their risk was calculated using their age and the presence of common genes for prostate cancer so while some men would start screening at age 45 others would start at age 60 and some would never be screened. The cost of both strategies was estimated on the basis of following a million men.

The model showed that the personalised approach would reduce the number of screening episodes by half and the number of men diagnosed with prostate cancer by 18%.

Personalised screening could cost £85m (€106m; $136m) less than age based screening and would be associated with 47 000 more QALYs. At a threshold of £20 000 the probability that the personalised screening strategy is cost effective compared with age based screening was 100%.

Nora Pashayan, a Cancer Research UK clinician scientist at University College London, presented the findings of the study at the National Cancer Research Institute conference in Liverpool on 5 November. She said: “We don’t have a screening programme for prostate cancer because the benefits are outweighed by the harms. Identifying men who are more likely to develop prostate cancer and targeting them for screening could potentially save thousands of men from overdiagnosis and unnecessary treatment. We’re now refining our model to develop more definite predictions which will then need to be tested in trials to see if this approach will have the effect we predict.”

Each year more than 40 000 men are diagnosed with prostate cancer in the UK and more than 10 500 men die from the disease.

Peter Johnson, Cancer Research UK’s chief clinician, said: “There is great uncertainty about the usefulness of screening for prostate cancer using the PSA [prostate specific antigen] test, with many men finding it difficult to weigh up the pros and cons. This research suggests an important way to select men for whom testing may be more worthwhile, which points us in the right direction for the future.”

Notes

Cite this as: BMJ 2012;345:e7467

Footnotes